Researchers at Sanford Roger Maris Cancer Center observed an increase in cancer-directed medication inpatient expenditures in 2017, so they implemented a formulary pathway and found that it decreased these associated expenses. The results of the study were presented by Jocelyn Mohs, PharmD, BCOP, pharmacy supervisor at Sanford Roger Maris Cancer Center, at HOPA’s 16th Annual Conference.

The Oncology Formulary Committee and hematology/oncology providers established a list of formulary parenteral and oral cancer-directed medications used in the inpatient setting. A peer-reviewed pathway was then created for any “non-formulary” request. The facility employed 13 full-time adult oncologist physicians (three had a hematology subspecialty) between 2017 and 2019.

When the pharmacists received an order for non-formulary chemotherapy, they completed a form to notify the ordering provider; they also circulated the form to three oncology committee providers. If at least two committee members approved, the non-formulary treatment could be administered, if not, the order was denied. Afterward, the pharmacist and provider were notified, and the request was reviewed via the oncology formulary.

After implementing this pathway, the average monthly cost of non-formulary inpatient cancer-directed therapy decreased from $27,965 per month in 2017 to $10,217 between January 2018 and June 2019—representing a 63% drop in monthly expenditures that was sustained for 18 months.

Aggregate inpatient cancer-directed expenditures decreased from $139,681 per month to $121,429 by the end of the study period (a 13% decrease), despite an increase in monthly inpatient discharges year-over-year, according to the authors.

“Opportunities to improve the program going forward include separating non-formulary requests for hematologic malignancies for review by hematology physician specialists,” the authors noted.